Just a bit of background info on my dad who was diagnosed in Feb last year;
T3b, N1 (left external iliac, bilateral common iliac, para aortic and bilateral hilar lymph nodes) M1b
L5 metastases, Gleason 4+4 adenocarcinoma of prostate
Presenting PSA: 97
He was initially placed on zoladex injections and was also placed on Enzalutamide around July 2019. His PSA has dropped to 1.3 currently. He has had two scans since and which he has been informed indicate no visible progression.
He has been offered radiotherapy on his prostate and we're currently trying to weigh up the pros and cons. From what I see, the side effects aren't too bad that he should turn this down but thought I would ask you fellas just to see if you think it's a good idea? I imagine a lot of you will have already had this done so it would be great to get your experiences! As ever, very grateful in advance for your responses (providing I get some haha.)
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Hillwalker87
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Make sure your radiation provider plans on using fiducials, 3 small gold implants in your prostate to assist targeting. Some lessor providers don’t do this.
Based on my own experience, with G4+4 (mine was G4+3), and his confirmed met outside of the prostate, I’d think that RT to the prostate will help in delaying future met, Furthermore, I’d also go through chemo-hormonal therapy now while he is still strong and healthy to be able to counter the chemo side effects. This step will hopefully neutralize mets that are already systemic. ADT alone will kill some of the cancer cells, chemo will take more of it, thus delaying any cancer progression, thus life. On the other hand, if your dad is much older then perhaps just go with the current treatment and be done with.
I think he may have too many metastases for it to have any oncological benefit. Two major randomized clinical trials showed there was no benefit unless the patient has fewer than 4 bone metastases. The hilar lymph nodes are not in the pelvic area and the para-aortics may not be either - they are stage M1a rather than N1.
However, there are other reasons to treat the prostate other than to increase survival. The prostate, when overridden with cancer can interfere with urination. I think it may not be a bad idea to treat it with SBRT (at perhaps a lower dose) if he has already begun to have urinary symptoms.
It is always comforting if PSA goes down because of it, even if there is no net benefit.
I had a 3 month injection of Zoladex on Nov 8th. Tolerable but night sweats deprive me of sleep-- low energy but not a show stopper, though no wood for a month now.
My Ono said I can discontinue since I'm T2 PSA 0.06. and after I complained about sweats and poor sleep. I start salvage radiation in next 12 days.
Hello HW,Good idea to copy and paste some of your Dad's bio into his/your homepage for future reference..... Give my regards to you Dad and ha ha back to you.......
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